HYPERCALCEMIC GOLDEN RETRIEVER
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1 Presenter: Laura Martínez 1, 2 HYPERCALCEMIC GOLDEN RETRIEVER Contributors: Laia Solano-Gallego 2, Josep Pastor 2, Alberto J. Marco 3, María Cuvertoret-Sanz 3, Rosa Novellas 1,2, Anna Vila 1, 2, Xavier Roura 1 1 Fundació Hospital Clinic Veterinari 2 Departament de Medicina i Cirurgia Animals, Facultat de Veterinària 3 Servei de diagnòstic d Anatomia Patològica. Departament de Sanitat i Anatomia Animals, Facultat de Veterinària Universitat Autònoma de Barcelona (UAB), Edifici V, Campus UAB, Bellaterra (Barcelona), Spain. SIGNALMENT Jako, 4 years old, male neutered Golden Retriever. HISTORY Jako was referred from his regular clinic to the small animal teaching hospital (Hospital Clinic Veterinari) at Universitat Autònoma de Barcelona (UAB), Spain, on March 22 nd 2017 with a history of weight loss, polyuria, polydipsia and hypercalcemia. The owners noticed that Jako refused to eat and he was not himself since seven days ago. One day before being referred, Jako s regular veterinarian performed a complete blood count (CBC) (Table 1), a biochemistry profile (Table 2) and urinalysis (Table 3). The major finding on the CBC was mild neutrophilic leukocytosis with mild left shift. The biochemistry profile showed marked hypercalcemia and severe hyperlipasemia. The other parameters altered were mild increase in creatinine and urea, mild increase in AST activity and very mild hyperbilirubinemia. The urinalysis was unremarkable with the exception of urine specific gravity of Jako was diagnosed of aortic stenosis when he was a puppy but he did not show clinical signs of cardiovascular disease during physical examination. Besides, Jako was not receiving any treatment regarding his heart disease at that time. CLINICAL FINDINGS On physical examination, Jako showed a heart murmur of 4 over 6. The rest of clinical examination was within normal limits. DIAGNOSTIC TEST Jako was hospitalized in the intensive care unit (ICU) for emergency treatment and monitoring of calcium levels, as well as, to complete the diagnostic workup. At the time of admission, Jako s calcium ionized concentration was 2.73 mmol/l (Reference interval: mmol/l,
2 IDEXX Vet Stat). Initially, the animal received fluidotherapy and furosemide at a dose of 2mg/kg every 12 hours. A biochemistry profile was performed the day after Jako s admission. The results are listed on table 2. The abdominal ultrasound revealed mild amount of abdominal fluid that was not sampled and multiple hepatic nodules of heterogeneous ecogenicity with moderate discrete margins and variable sized, ranging from 0.8 to 3.5 cm. The abdominal ultrasound also displayed mild mesenteric lymphadenomegaly. An ultrasound-guided fine needle aspiration biopsy of the hepatic nodules was performed (figure 1). Figure 1. Hepatic nodule of heterogeneous ecogenicity with moderate discrete margins
3 Table 1. Hematological results of the patient March 21 st (Sysmex XT2000 ) 1 Parameters (units) Result Reference interval RBCs (x10 6 /µl) Hematocrit (%) Hemoglobin (g/dl) MCV (fl) RDW (%) Reticulocytes (x10 3 cells/ µl) 13,310 10, ,000 WBC (x10 3 cells/ µl) Neutrophils (cells/ µl) 15,392 2,940 12,670 Band cells (cells/ µl) Lymphocytes (cells/ µl) 2, Monocytes (cells/ µl) ,150 Eosinophils (cells/ µl) ,490 Basophils (cells/ µl) Platelets (x10 3 cells/ µl) Results obtained from an external referral laboratory (IDEXX Laboratories) one day before the admission. 2 Peripheral blood smear was done and a high number of platelet clumps were observed; therefore, the platelet concentration was considered within reference intervals.
4 Table 2. Biochemistry results of the patient March 21 st (Beckman Coulter AU640) 1 March 23 rd (Olympus AU400) 2 Parameters (units) Result Reference interval Result Reference interval Proteins (g/dl) Albumin (g/dl) Globulins (g/dl) ALT (UI/L) AST (UI/L) ALP (UI/L) Not performed Total bilirubin (mg/dl) Total calcium (mg/dl) Phosphorus (mg/dl) Creatinine (mg/dl) Urea (mg/dl) Sodium (meq/l) Potassium (meq/l) , Chloride (meq/l) Glucose (mg/dl) Cholesterol (mg/dl) Lipase (UI/L) 15, Not performed Amylase (UI/L) Results obtained from an external referral laboratory (IDEXX Laboratories) one day before the admission. 2 Results obtained at biochemistry laboratory in the Hospital Clinic Veterinari (UAB) one day after admission. Table 3. Urinalysis March 21 st IDEXX Laboratories 1 Color Yellow ph 6.5 Glucose Ketones Bilirubin RBC/Hemoglobin Proteins Urine specific gravity (USG) Results obtained from an external referral laboratory (IDEXX Laboratories) one day before the admission. The urinary sediment was inactive. The protein/creatinine ratio was performed and the result was 0.19.
5 Figure 2. Fine needle aspirate of hepatic nodule, 200x (Quick Panoptic stain). Figure 3. Hepatic nodule aspirate, 400x (Quick Panoptic stain).
6 Figure 4. Hepatic mass aspirate, 400x (Diff Quick Panoptic stain). QUESTIONS 1. How would you interpret the test results performed on Jako? 2. What is your cytological interpretation? 3. What other test would you recommend in this patient?
COMPANY OR UNIVERSITY
CONTRIBUTOR NAME Daniel Heinrich, DVM CONTRIBUTOR EMAIL dheinric@umn.edu COAUTHORS Jed Overmann, DVM, DACVP; Davis Seelig DVM, PhD, DACVP & Matthew Sturos, DVM COMPANY OR UNIVERSITY University of Minnesota
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